Healthcare Provider Details

I. General information

NPI: 1134713175
Provider Name (Legal Business Name): ALEXIS KEMP CERT.LIAISONADVOCATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 02/21/2021
Certification Date: 02/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 MARINWOOD DR
HOUSTON TX
77053-4359
US

IV. Provider business mailing address

6503 MARINWOOD DR
HOUSTON TX
77053-4359
US

V. Phone/Fax

Practice location:
  • Phone: 832-908-0590
  • Fax:
Mailing address:
  • Phone: 832-908-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020171136
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number2020171136
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2020171136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: